| NPI | 1265141949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305215528) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 049653) |
| Enumeration Date | 2022-11-21 |
| Last Update Date | 2023-01-11 |