| NPI | 1457492316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NY 002736-1) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: NY 014257-1) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2013-04-05 |