| NPI | 1336771146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 14206) |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy (Licence: NY 043695) |
| Enumeration Date | 2020-02-10 |
| Last Update Date | 2023-10-11 |