| NPI | 1033768403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 012815) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 044432-01) |
| Enumeration Date | 2019-09-09 |
| Last Update Date | 2025-04-04 |