| NPI | 1104339860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 037674) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1277190) |
| Enumeration Date | 2017-11-15 |
| Last Update Date | 2019-10-22 |