| NPI | 1811175078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT24818) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 029771) |
| Enumeration Date | 2008-02-09 |
| Last Update Date | 2023-07-10 |