| NPI | 1144453531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL FLPT25851) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 031581) |
| Enumeration Date | 2009-09-01 |
| Last Update Date | 2015-06-26 |