| NPI | 1225368467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 25458) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 032291) |
| Enumeration Date | 2010-01-11 |
| Last Update Date | 2012-05-10 |