| NPI | 1447905864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 048557) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 25981) |
| Enumeration Date | 2022-02-14 |
| Last Update Date | 2023-12-20 |