| NPI | 1568520310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 018508) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: NY 018508) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NY 069502483) | |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2013-11-19 |