| NPI | 1780974543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 032265) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NY 007157) |
| Enumeration Date | 2011-04-13 |
| Last Update Date | 2023-02-10 |