| NPI | 1609867944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 0103951) |
| Additional Taxonomies | 2251N0400X Physical Therapist, Neurology (Licence: NY 0103951) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: NY 0103951) | |
| Enumeration Date | 2005-11-04 |
| Last Update Date | 2019-01-25 |