| NPI | 1760006548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KS 11-06442) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 047928) |
| Enumeration Date | 2020-06-08 |
| Last Update Date | 2026-06-25 |