| NPI | 1225697741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 040900) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 300352) |
| Enumeration Date | 2019-06-08 |
| Last Update Date | 2025-03-17 |