| NPI | 1275407975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 038933) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J1-0002688) |
| Enumeration Date | 2025-10-03 |
| Last Update Date | 2025-11-17 |