| NPI | 1891125449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 037160) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070029553) |
| 225100000X Physical Therapist (Licence: MN 14159) | |
| Enumeration Date | 2013-11-18 |
| Last Update Date | 2025-10-28 |