| NPI | 1184478166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 051657) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VT 040.0134726PROV) |
| Enumeration Date | 2024-04-15 |
| Last Update Date | 2024-04-24 |