| NPI | 1356311567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 0265781) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1191533) |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2011-04-05 |