| NPI | 1023380011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 3229) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 015382-1) |
| Enumeration Date | 2012-02-06 |
| Last Update Date | 2012-02-06 |