| NPI | 1396308938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 28114) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 037021) |
| Enumeration Date | 2019-04-18 |
| Last Update Date | 2026-07-26 |