| NPI | 1285871095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 031038) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT34461) |
| Enumeration Date | 2009-01-15 |
| Last Update Date | 2019-08-19 |