| NPI | 1720021025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 018121-1) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: NY 018121-1) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2015-05-15 |