| NPI | 1508644600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 050776) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 15337) |
| Enumeration Date | 2023-09-19 |
| Last Update Date | 2023-10-02 |