| NPI | 1922613033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 055136) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2020025036) |
| Enumeration Date | 2020-09-15 |
| Last Update Date | 2025-10-09 |