| NPI | 1528496692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: NY 035172-1) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 2251X0800X Physical Therapist, Orthopedic | |
| Enumeration Date | 2013-10-28 |
| Last Update Date | 2013-10-28 |