| NPI | 1114381811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 043937-1) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NY 010061-1) |
| Enumeration Date | 2016-04-08 |
| Last Update Date | 2019-12-16 |