| NPI | 1174120299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 048595-01) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J1-0003864) |
| Enumeration Date | 2020-10-01 |
| Last Update Date | 2025-09-01 |