| NPI | 1649326836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305206526) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 025229) |
| Enumeration Date | 2007-01-28 |
| Last Update Date | 2025-06-24 |