| NPI | 1912471996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 044047) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: 40QA01832100) |
| Enumeration Date | 2019-01-14 |
| Last Update Date | 2025-05-02 |