| NPI | 1346991312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 30699) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 048095) |
| Enumeration Date | 2022-01-12 |
| Last Update Date | 2025-12-29 |