| NPI | 1376618165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 023139) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: NY 0231391) |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2021-04-08 |