| NPI | 1255142725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 14638) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 053796) |
| Enumeration Date | 2025-01-15 |
| Last Update Date | 2025-01-15 |