| NPI | 1083340509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MS PT7279) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 040194) |
| Enumeration Date | 2022-07-27 |
| Last Update Date | 2022-08-05 |