| NPI | 1427118009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 0069402) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X006113-1) |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2022-11-21 |