| NPI | 1568618817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 030729) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 008387) |
| Enumeration Date | 2008-08-18 |
| Last Update Date | 2022-04-12 |