| NPI | 1497920888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT24682) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 029523) |
| 225700000X Massage Therapist (Licence: NY 017516) | |
| Enumeration Date | 2008-04-25 |
| Last Update Date | 2009-08-31 |