| NPI | 1245303791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 13393) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 0227091) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2025-06-04 |