| NPI | 1588200745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT032753) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 045149) |
| Enumeration Date | 2019-11-22 |
| Last Update Date | 2024-11-26 |