| NPI | 1528366069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305214472) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 033464) |
| Enumeration Date | 2011-03-08 |
| Last Update Date | 2021-10-15 |