| NPI | 1073064937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 041216) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1282550) |
| Enumeration Date | 2016-10-17 |
| Last Update Date | 2020-11-15 |