| NPI | 1316416647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 043463) |
| Enumeration Date | 2018-11-15 |
| Last Update Date | 2020-07-31 |