| NPI | 1568548659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 004780-1) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X003779-1) |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2017-02-22 |