| NPI | 1255114989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 050727) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NY 2000005462) |
| Enumeration Date | 2023-08-16 |
| Last Update Date | 2025-02-04 |