| NPI | 1255917316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 021504-01) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 021504-1) |
| Enumeration Date | 2021-03-19 |
| Last Update Date | 2025-07-05 |