| NPI | 1689142200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 043707) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 301989) |
| Enumeration Date | 2018-11-13 |
| Last Update Date | 2025-10-07 |