| NPI | 1144887597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 035793) |
| Enumeration Date | 2019-05-21 |
| Last Update Date | 2022-08-11 |