| NPI | 1801533708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 29393) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 047210) |
| Enumeration Date | 2022-05-12 |
| Last Update Date | 2024-12-10 |