| NPI | 1164529715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 028303) |
| Additional Taxonomies | 313M00000X Nursing Facility/Intermediate Care Facility (Licence: IN 05009075A) |
| Enumeration Date | 2006-09-17 |
| Last Update Date | 2007-07-08 |