| NPI | 1184347346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 048879) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 37340) |
| Enumeration Date | 2022-09-22 |
| Last Update Date | 2022-11-10 |