| NPI | 1992889745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT24961) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 014155) |
| 225100000X Physical Therapist (Licence: CT 005142) | |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2024-08-22 |