| NPI | 1326765603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 1757524) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 049553) |
| Enumeration Date | 2022-10-26 |
| Last Update Date | 2026-05-07 |