| NPI | 1740621770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 24395) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 24396) |
| 225100000X Physical Therapist (Licence: NY 031034) | |
| Enumeration Date | 2013-07-05 |
| Last Update Date | 2020-05-21 |