| NPI | 1235992751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 30269) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 046833) |
| Enumeration Date | 2024-02-06 |
| Last Update Date | 2025-02-03 |