| NPI | 1053554048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 031219) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 41470) |
| Enumeration Date | 2009-04-07 |
| Last Update Date | 2024-06-21 |