| NPI | 1679985535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 37344) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 294694) |
| 225100000X Physical Therapist (Licence: VA 2305208592) | |
| Enumeration Date | 2014-05-27 |
| Last Update Date | 2019-02-21 |