| NPI | 1346244878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: 174861) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 0174861) |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2019-05-06 |