| NPI | 1659319440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 034111) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 8813) |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2016-09-28 |