| NPI | 1760962062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: NY 043149-1) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: NY 043149-1) | |
| Enumeration Date | 2018-08-16 |
| Last Update Date | 2021-07-01 |