| NPI | 1790228633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: OR 62581) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 041152-1) |
| Enumeration Date | 2016-11-26 |
| Last Update Date | 2023-04-07 |