| NPI | 1255589271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 008433) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 030544-1) |
| Enumeration Date | 2008-09-03 |
| Last Update Date | 2016-08-15 |