| NPI | 1144367848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 0345901) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X008716-1) |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2024-05-20 |