| NPI | 1639877418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL0019277) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 050173) |
| Enumeration Date | 2023-02-21 |
| Last Update Date | 2025-04-08 |