| NPI | 1285156562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 40103) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 037263) |
| Enumeration Date | 2017-07-09 |
| Last Update Date | 2025-06-18 |