| NPI | 1568115939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 41827) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 047605) |
| Enumeration Date | 2022-01-27 |
| Last Update Date | 2025-08-27 |