| NPI | 1750559597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: NY 029930) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: NY 029930) |
| Enumeration Date | 2008-02-14 |
| Last Update Date | 2023-05-02 |