| NPI | 1477707867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 013417-1) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 03147) |
| Enumeration Date | 2008-11-11 |
| Last Update Date | 2025-06-18 |