| NPI | 1295489318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT37741) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 041172-01) |
| Enumeration Date | 2022-02-08 |
| Last Update Date | 2022-02-08 |