| NPI | 1639507940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 28842) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 036080) |
| Enumeration Date | 2013-10-23 |
| Last Update Date | 2014-03-19 |