| NPI | 1396395653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA 029971) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 044937) |
| Enumeration Date | 2019-09-18 |
| Last Update Date | 2022-05-05 |