| NPI | 1982436986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ME 7055) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 052503) |
| 225100000X Physical Therapist (Licence: VA 2305216859) | |
| 225100000X Physical Therapist (Licence: CT 13801) | |
| 225100000X Physical Therapist (Licence: NJ 40QA02263800) | |
| Enumeration Date | 2024-08-17 |
| Last Update Date | 2025-04-01 |