| NPI | 1871556498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 0166051) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 016605-1) |
| Enumeration Date | 2006-04-07 |
| Last Update Date | 2024-02-10 |