| NPI | 1346304615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 012834) |
| Additional Taxonomies | 2251H1200X Physical Therapist, Hand (Licence: NY 1041100058) |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2019-08-15 |