| NPI | 1992893135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 274308) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: NY 023651) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2024-04-17 |