| NPI | 1285045484 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 032891) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: NY 032891) |
| Enumeration Date | 2014-05-11 |
| Last Update Date | 2024-01-25 |