| NPI | 1316871445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 66070) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 054790) |
| Enumeration Date | 2026-06-12 |
| Last Update Date | 2026-06-12 |