| NPI | 1396956355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 009820) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 029149) |
| 225100000X Physical Therapist (Licence: CT 9820) | |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2022-09-16 |