| NPI | 1205340270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy (Licence: NY 039896-1) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 039896-1) |
| Enumeration Date | 2017-11-28 |
| Last Update Date | 2017-11-28 |