| NPI | 1669576815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 007612) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 036330-1) |
| Enumeration Date | 2006-09-09 |
| Last Update Date | 2016-07-28 |