| NPI | 1104092071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 26625) |
| Additional Taxonomies | 261QH0100X Clinic/Center, Health Services (Licence: 0266) |
| Enumeration Date | 2008-05-01 |
| Last Update Date | 2009-01-06 |