| NPI | 1700454337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT39667) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 046172) |
| Enumeration Date | 2021-06-10 |
| Last Update Date | 2025-01-14 |