| NPI | 1063462927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 5808) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X005018) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2011-09-12 |