| NPI | 1659431617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 009781-1) |
| Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: NY 018598) |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2020-08-06 |