| NPI | 1285235622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 30615) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 046729) |
| Enumeration Date | 2020-11-03 |
| Last Update Date | 2026-03-16 |