| NPI | 1316922297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: FL PT36300) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 16367) |
| 2251G0304X Physical Therapist Geriatrics (Licence: NY 16367) | |
| 2251S0007X Physical Therapist Sports (Licence: NY 16367) | |
| 2251X0800X Physical Therapist Orthopedic (Licence: NY 16367) | |
| Enumeration Date | 2005-12-13 |
| Last Update Date | 2021-12-03 |