| NPI | 1063067494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 4390) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 035429) |
| Enumeration Date | 2019-08-02 |
| Last Update Date | 2023-10-26 |