| NPI | 1205362845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 22818) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 30016) |
| Enumeration Date | 2017-05-02 |
| Last Update Date | 2017-05-02 |