| NPI | 1518515402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: NY 044740-01) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CT 12437) |
| Enumeration Date | 2019-09-03 |
| Last Update Date | 2023-04-06 |