| NPI | 1184090458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 11176) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist (Licence: NY 039000) | |
| Enumeration Date | 2015-08-20 |
| Last Update Date | 2025-09-30 |