| NPI | 1285106823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 27437) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: NY 043957) |
| Enumeration Date | 2018-12-20 |
| Last Update Date | 2020-09-10 |