| NPI | 1427521632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT27127) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 026420-1) |
| Enumeration Date | 2019-01-10 |
| Last Update Date | 2019-01-10 |