| NPI | 1194893750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 008717-1) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 0087171) |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2008-07-31 |