| NPI | 1245975663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 044101-01) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NY 011961-01) |
| Enumeration Date | 2022-04-29 |
| Last Update Date | 2026-07-18 |