| NPI | 1780703116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 025711) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01216300) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: NY 025711) | |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2022-01-16 |