| NPI | 1205442563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 40424) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 046113) |
| Enumeration Date | 2020-09-21 |
| Last Update Date | 2023-07-14 |