| NPI | 1326684200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: NY 037253) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: NY 37253) |
| Enumeration Date | 2019-11-26 |
| Last Update Date | 2023-07-03 |