| NPI | 1508278508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT024351) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 036108) |
| Enumeration Date | 2014-05-24 |
| Last Update Date | 2015-08-06 |