| NPI | 1841085255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 052531) |
| Additional Taxonomies | 2251C2600X Physical Therapist Cardiopulmonary (Licence: NY 052531) |
| 2251G0304X Physical Therapist Geriatrics (Licence: NY 052531) | |
| 2251N0400X Physical Therapist Neurology (Licence: NY 052531) | |
| Enumeration Date | 2025-04-14 |
| Last Update Date | 2025-04-14 |