| NPI | 1972275840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT44722) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY PT047500) |
| Enumeration Date | 2021-09-29 |
| Last Update Date | 2026-06-19 |