| NPI | 1639400849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 028976) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 0021209) |
| 225100000X Physical Therapist (Licence: CT 15250) | |
| Enumeration Date | 2010-01-28 |
| Last Update Date | 2026-04-26 |