| NPI | 1992203400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 039369) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305211599) |
| Enumeration Date | 2018-01-30 |
| Last Update Date | 2018-01-30 |