| NPI | 1700544194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305215613) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 048132) |
| Enumeration Date | 2021-12-02 |
| Last Update Date | 2024-04-17 |