| NPI | 1669837092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 25819) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 039617) |
| Enumeration Date | 2015-12-30 |
| Last Update Date | 2015-12-30 |