| NPI | 1174343305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: NY 049390) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports |
| Enumeration Date | 2024-10-14 |
| Last Update Date | 2024-10-14 |