| NPI | 1093418162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 050529-01) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 26677) |
| Enumeration Date | 2023-03-27 |
| Last Update Date | 2023-09-07 |