| NPI | 1831558139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251S0007X Physical Therapist, Sports (Licence: NY 018934) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: NY 018-934) |
| Enumeration Date | 2016-02-15 |
| Last Update Date | 2024-02-05 |