| NPI | 1487807301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 039512) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 008405) |
| Enumeration Date | 2008-10-23 |
| Last Update Date | 2020-04-08 |