| NPI | 1861792509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 10329) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 032366) |
| Enumeration Date | 2010-10-28 |
| Last Update Date | 2026-01-27 |