| NPI | 1275077794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 21077) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 036082) |
| Enumeration Date | 2016-12-19 |
| Last Update Date | 2016-12-19 |