| NPI | 1184326092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 052245) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1374974) |
| Enumeration Date | 2023-03-22 |
| Last Update Date | 2025-09-15 |