| NPI | 1770128746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 4240) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 032653) |
| Enumeration Date | 2019-11-13 |
| Last Update Date | 2023-10-31 |