| NPI | 1184695439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 025940-1) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY x010884-1) |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2012-09-15 |