| NPI | 1669142923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 5023) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 045872-01) |
| Enumeration Date | 2021-09-17 |
| Last Update Date | 2026-07-13 |