| NPI | 1518306547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT 27618) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 034243) |
| Enumeration Date | 2013-06-24 |
| Last Update Date | 2013-06-24 |