| NPI | 1629594767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 011639) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 042161) |
| Enumeration Date | 2017-08-21 |
| Last Update Date | 2025-07-21 |