| NPI | 1871034553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 041524) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 306256) |
| Enumeration Date | 2017-03-15 |
| Last Update Date | 2024-07-15 |