| NPI | 1396089207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 042355) |
| Additional Taxonomies | 174400000X Specialist (Licence: NM 42222) |
| Enumeration Date | 2012-11-15 |
| Last Update Date | 2020-07-02 |