NPI | 1619040425 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 10183) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 017307-1) |
Enumeration Date | 2006-11-17 |
Last Update Date | 2025-04-22 |