| NPI | 1982138145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 041476) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 041476) |
| Enumeration Date | 2017-04-14 |
| Last Update Date | 2022-07-27 |