| NPI | 1417122334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 62027639) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 8150) |
| Enumeration Date | 2008-04-23 |
| Last Update Date | 2009-02-09 |