| NPI | 1104065408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171W00000X Contractor (Licence: NY 011824) |
| Additional Taxonomies | 172M00000X Mechanotherapist (Licence: NY 011824) |
| Enumeration Date | 2009-02-10 |
| Last Update Date | 2009-02-10 |