| NPI | 1265551618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 016841) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: NY 016841) |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2012-06-08 |