| NPI | 1578286134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 047100) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 047100) |
| Enumeration Date | 2022-09-20 |
| Last Update Date | 2024-04-15 |