| NPI | 1134441645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 010780) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 34514) |
| Enumeration Date | 2010-02-24 |
| Last Update Date | 2010-02-24 |