| NPI | 1336794288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 62014107) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 18076) |
| Enumeration Date | 2019-08-07 |
| Last Update Date | 2020-06-03 |