| NPI | 1639624398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 011011) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 044376) |
| Enumeration Date | 2016-08-23 |
| Last Update Date | 2026-03-26 |