| NPI | 1528389897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: NY 6014) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: NY 6014) |
| 2251S0007X Physical Therapist, Sports (Licence: NY 6014) | |
| Enumeration Date | 2010-06-21 |
| Last Update Date | 2010-06-21 |