| NPI | 1437280245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 05008117A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 026027A) |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2012-07-27 |