| NPI | 1164259552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 052834) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 12580) |
| Enumeration Date | 2024-09-18 |
| Last Update Date | 2024-09-23 |