| NPI | 1043245392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 019429) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 019429) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2017-06-23 |