| NPI | 1366461717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: NY 028089) |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy (Licence: NY 028089) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2023-02-18 |