| NPI | 1205563020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 261QP2000X Clinic/Center Physical Therapy (Licence: NY 050834) |
| Enumeration Date | 2022-08-02 |
| Last Update Date | 2023-10-26 |