| NPI | 1497453260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 048970) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 048970) |
| Enumeration Date | 2023-02-21 |
| Last Update Date | 2023-03-28 |