| NPI | 1528604394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 29147) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 044289) |
| Enumeration Date | 2019-11-26 |
| Last Update Date | 2023-03-14 |