| NPI | 1194383927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 044403-01) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 24261) |
| Enumeration Date | 2019-06-05 |
| Last Update Date | 2024-04-12 |