| NPI | 1407865280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: NY 028390) |
| Additional Taxonomies | 111NX0800X Chiropractor Orthopedic (Licence: NY X008418-1) |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2020-05-21 |