| NPI | 1417080870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 027806-1) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05008904A) |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2016-10-11 |