| NPI | 1679619068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X (Licence: NY X011325-1) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 005096-1) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2007-07-08 |