| NPI | 1508068107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 019129-1) |
| Additional Taxonomies | 225000000X Orthotic Fitter (Licence: NY ABC Fitter) |
| Enumeration Date | 2007-06-05 |
| Last Update Date | 2020-03-10 |