| NPI | 1235463761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 019393-1) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 28130) |
| Enumeration Date | 2009-09-30 |
| Last Update Date | 2009-09-30 |