| NPI | 1780084160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: NY 044220) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: NJ 40QA01568900) |
| Enumeration Date | 2014-09-03 |
| Last Update Date | 2021-04-08 |