| NPI | 1275192320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 053640-01) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2019-06-12 |
| Last Update Date | 2024-12-24 |