| NPI | 1992126114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA PTL21781) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 035771) |
| Enumeration Date | 2013-12-16 |
| Last Update Date | 2023-09-04 |