| NPI | 1598540718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 050964) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05015335A) |
| Enumeration Date | 2023-08-28 |
| Last Update Date | 2025-10-31 |