| NPI | 1881055697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 32409) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 039022-1) |
| Enumeration Date | 2016-03-08 |
| Last Update Date | 2021-09-08 |