| NPI | 1376879379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA 018666) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 028544) |
| Enumeration Date | 2009-10-26 |
| Last Update Date | 2009-10-26 |