| NPI | 1558592857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: NY 030551) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NY 006342) |
| 225100000X Physical Therapist (Licence: NY 030551) | |
| 2251S0007X Physical Therapist, Sports (Licence: NY 030551) | |
| Enumeration Date | 2009-08-04 |
| Last Update Date | 2019-09-22 |