| NPI | 1174773162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT 27814) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 030564) |
| Enumeration Date | 2008-09-25 |
| Last Update Date | 2016-05-10 |