| NPI | 1619040425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 10183) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 017307-1) |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2025-04-22 |