| NPI | 1801386503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: NY 042929) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 042929) |
| Enumeration Date | 2018-05-17 |
| Last Update Date | 2025-04-18 |