| NPI | 1679907216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 036945) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NY 008764) |
| Enumeration Date | 2013-08-31 |
| Last Update Date | 2014-04-17 |