| NPI | 1992727218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 10709) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: NY 014665-1) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2024-06-04 |