| NPI | 1609249960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: NY 034904) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 034904) |
| 2251G0304X Physical Therapist, Geriatrics (Licence: NY 034904) | |
| 2251P0200X Physical Therapist, Pediatrics (Licence: NY 034904) | |
| 2251S0007X Physical Therapist, Sports (Licence: NY 034904) | |
| Enumeration Date | 2015-11-09 |
| Last Update Date | 2020-08-10 |