| NPI | 1992338750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: NY 047687) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA PT028341) |
| Enumeration Date | 2020-02-19 |
| Last Update Date | 2021-10-05 |