| NPI | 1831233774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 7883) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 0260601) |
| Enumeration Date | 2007-02-16 |
| Last Update Date | 2026-01-07 |