| NPI | 1558845438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 043410-1) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 043410) |
| Enumeration Date | 2018-09-18 |
| Last Update Date | 2018-10-15 |