| NPI | 1114479474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 045939) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NY 009199) |
| Enumeration Date | 2016-11-02 |
| Last Update Date | 2020-08-19 |