| NPI | 1154468569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 022885) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 022885) |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2016-02-02 |