| NPI | 1144450222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 17495) |
| Additional Taxonomies | 251E00000X Home Health (Licence: NY 17495) |
| 261QP2000X Clinic/Center, Physical Therapy (Licence: NY 17495) | |
| Enumeration Date | 2009-07-22 |
| Last Update Date | 2022-04-04 |