| NPI | 1275101289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 2251S0007X Physical Therapist Sports (Licence: NY 047124) |
| Enumeration Date | 2021-06-15 |
| Last Update Date | 2025-03-14 |