| NPI | 1396793014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT42931) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 028155) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2025-07-30 |