| NPI | 1275956609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 35990) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT21817) |
| 225100000X Physical Therapist (Licence: NY 62 026558) | |
| Enumeration Date | 2014-01-21 |
| Last Update Date | 2022-02-11 |