| NPI | 1255924254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: NY 048051-01) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 299931) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: NJ 40QA02235700) | |
| Enumeration Date | 2021-02-19 |
| Last Update Date | 2025-08-11 |