| NPI | 1861430191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 22003) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 011273) |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2025-03-07 |