| NPI | 1245566280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 031277) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 031277-1) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: NY 031277) | |
| Enumeration Date | 2009-10-27 |
| Last Update Date | 2020-07-08 |