| NPI | 1295087716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 30149) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 035492) |
| Enumeration Date | 2012-10-08 |
| Last Update Date | 2015-05-25 |