| NPI | 1043359599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 018643) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 11251) |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2008-08-20 |