| NPI | 1548960552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT40111) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 050009) |
| Enumeration Date | 2023-03-08 |
| Last Update Date | 2026-05-29 |