| NPI | 1437766516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 12871) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 046014) |
| Enumeration Date | 2020-09-23 |
| Last Update Date | 2020-09-23 |