| NPI | 1023765005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NY 012312-01) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 045098-01) |
| Enumeration Date | 2022-03-09 |
| Last Update Date | 2022-03-09 |