| NPI | 1780562959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 054606) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA02366700) |
| Enumeration Date | 2025-08-25 |
| Last Update Date | 2026-03-01 |