| NPI | 1326544693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NY P09803) |
| Enumeration Date | 2018-04-04 |
| Last Update Date | 2023-06-21 |