| NPI | 1528583655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 23293) |
| Additional Taxonomies | 2251G0304X Physical Therapist Geriatrics (Licence: NY 039342) |
| 2251N0400X Physical Therapist Neurology (Licence: NY 039342) | |
| 2251X0800X Physical Therapist Orthopedic (Licence: NY 039342) | |
| Enumeration Date | 2017-08-09 |
| Last Update Date | 2023-02-14 |