| NPI | 1528607009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 045425) |
| Enumeration Date | 2019-12-31 |
| Last Update Date | 2023-05-05 |