| NPI | 1326411547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 9966) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 036234) |
| Enumeration Date | 2015-11-10 |
| Last Update Date | 2023-10-19 |