| NPI | 1407561194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA PTL26907) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 049687) |
| Enumeration Date | 2023-01-18 |
| Last Update Date | 2025-10-15 |