| NPI | 1295955615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 3015) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 003920-01) |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2023-01-16 |