| NPI | 1770255655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 047745-01) |
| Enumeration Date | 2021-09-29 |
| Last Update Date | 2021-09-29 |