| NPI | 1568127876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 038097) |
| Additional Taxonomies | 2251G0304X Physical Therapist Geriatrics (Licence: NY 038097) |
| 2251X0800X Physical Therapist Orthopedic (Licence: NY 038097) | |
| Enumeration Date | 2021-11-02 |
| Last Update Date | 2022-11-27 |