| NPI | 1457029217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 14611) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 047405-01) |
| Enumeration Date | 2021-09-05 |
| Last Update Date | 2024-09-03 |