| NPI | 1619622677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 048455) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: NY 048455-01) |
| Enumeration Date | 2022-02-18 |
| Last Update Date | 2022-12-20 |