| NPI | 1952886913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 041252-1) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: NY 041252) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: NY 041252) | |
| 2251G0304X Physical Therapist, Geriatrics (Licence: NY 041252) | |
| Enumeration Date | 2018-09-26 |
| Last Update Date | 2026-04-06 |