| NPI | 1780922591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: NY 034532) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2013-01-29 |
| Last Update Date | 2017-03-10 |