| NPI | 1982840781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 8812) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 008812-01) |
| Enumeration Date | 2008-12-29 |
| Last Update Date | 2025-06-29 |