| NPI | 1326455262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 022832) |
| Additional Taxonomies | 302F00000X Exclusive Provider Organization (Licence: NY 022832) |
| Enumeration Date | 2014-07-11 |
| Last Update Date | 2016-09-14 |