| NPI | 1750794806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy (Licence: SC 8542) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 037720) |
| Enumeration Date | 2014-06-06 |
| Last Update Date | 2022-11-26 |