| NPI | 1407190648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT39474) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 035744) |
| Enumeration Date | 2012-11-11 |
| Last Update Date | 2022-10-06 |