| NPI | 1245988120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305214744) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 010839) |
| 225100000X Physical Therapist (Licence: NY 039677) | |
| Enumeration Date | 2022-03-10 |
| Last Update Date | 2022-03-10 |