| NPI | 1013031467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 0110548-1) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT37418) |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2021-10-17 |