| NPI | 1215223219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: NY 014154-1) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: NY 014154-1) |
| Enumeration Date | 2011-06-28 |
| Last Update Date | 2011-06-28 |