| NPI | 1730694753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT35890) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 042935) |
| Enumeration Date | 2017-12-13 |
| Last Update Date | 2021-07-28 |