| NPI | 1124531587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 010065) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 037384) |
| Enumeration Date | 2017-11-08 |
| Last Update Date | 2017-11-08 |