| NPI | 1528845161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 051942-01) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports |
| Enumeration Date | 2023-09-08 |
| Last Update Date | 2025-03-09 |