| NPI | 1144372293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 015279-1) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE JI-00001061) |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2014-09-16 |