| NPI | 1972726909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 021295) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 021295) |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2023-06-19 |