| NPI | 1316656036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT42868) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 049656) |
| Enumeration Date | 2022-11-21 |
| Last Update Date | 2026-05-04 |