| NPI | 1982499117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 051470) |
| Additional Taxonomies | 224Y00000X Clinical Exercise Physiologist |
| Enumeration Date | 2025-04-09 |
| Last Update Date | 2025-08-14 |