| NPI | 1912894486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 054089) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT40693) |
| Enumeration Date | 2025-06-18 |
| Last Update Date | 2025-06-18 |