| NPI | 1740804939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 045942) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305213274) |
| 225100000X Physical Therapist (Licence: SC 10051) | |
| 225100000X Physical Therapist (Licence: NJ 40QA01947500) | |
| Enumeration Date | 2020-06-03 |
| Last Update Date | 2021-11-24 |