| NPI | 1306507116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 048315) |
| Enumeration Date | 2022-01-04 |
| Last Update Date | 2022-01-04 |