| NPI | 1245307537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH7149) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 0179911) |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2026-04-27 |