| NPI | 1225918410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT44106) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 054730-01) |
| Enumeration Date | 2025-09-06 |
| Last Update Date | 2025-12-17 |