| NPI | 1104581248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 047376) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA02326900) |
| 225100000X Physical Therapist (Licence: MA 26504) | |
| Enumeration Date | 2021-11-03 |
| Last Update Date | 2025-09-26 |