| NPI | 1326929472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 16835) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 055013-01) |
| Enumeration Date | 2025-09-08 |
| Last Update Date | 2025-09-15 |