| NPI | 1023551199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA PT016238) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 041009) |
| Enumeration Date | 2016-11-22 |
| Last Update Date | 2023-01-19 |