| NPI | 1164857108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 036479-1) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT023126) |
| Enumeration Date | 2013-09-10 |
| Last Update Date | 2013-09-10 |