| NPI | 1104172923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 28078) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 035213-1) |
| Enumeration Date | 2012-07-30 |
| Last Update Date | 2016-03-21 |