| NPI | 1275345258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305216923) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 053723) |
| Enumeration Date | 2025-01-24 |
| Last Update Date | 2025-02-05 |