| NPI | 1346629284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 11302) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 038835) |
| Enumeration Date | 2015-05-26 |
| Last Update Date | 2021-01-15 |