NPI | 1679751044 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 025391) |
Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy (Licence: NY 025391) |
Enumeration Date | 2008-02-07 |
Last Update Date | 2020-07-16 |