| NPI | 1609691484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 053429) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 13180) |
| Enumeration Date | 2024-11-18 |
| Last Update Date | 2026-01-05 |