| NPI | 1205015252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 045495) |
| Additional Taxonomies | 2081N0008X Physical Medicine & Rehabilitation, Neuromuscular Medicine (Licence: PA PT015287) |
| Enumeration Date | 2007-10-26 |
| Last Update Date | 2022-10-13 |