| NPI | 1023301116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 034653-1) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 14.009061) |
| Enumeration Date | 2011-05-23 |
| Last Update Date | 2012-01-24 |