| NPI | 1275906265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 27811) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 038807) |
| Enumeration Date | 2015-11-12 |
| Last Update Date | 2021-05-13 |