| NPI | 1851664171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 7731) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 029781-1) |
| Enumeration Date | 2012-02-16 |
| Last Update Date | 2025-08-14 |