| NPI | 1568977585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: NY 048026) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: NJ 40QA01768200) |
| Enumeration Date | 2017-12-13 |
| Last Update Date | 2026-05-25 |