| NPI | 1710691621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 049821) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1371388) |
| 225100000X Physical Therapist | |
| Enumeration Date | 2023-01-06 |
| Last Update Date | 2025-05-28 |