NPI | 1174120299 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 048595-01) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J1-0003864) |
Enumeration Date | 2020-10-01 |
Last Update Date | 2025-09-01 |