| NPI | 1225249261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT018987) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 62029286) |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2025-06-20 |