| NPI | 1215242375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 006406) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 62016632) |
| Enumeration Date | 2010-08-13 |
| Last Update Date | 2010-08-13 |