| NPI | 1770271561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 050540) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 013818) |
| Enumeration Date | 2023-04-28 |
| Last Update Date | 2023-07-07 |