| NPI | 1689950941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 034224) |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy (Licence: FL PT 27022) |
| Enumeration Date | 2011-10-31 |
| Last Update Date | 2013-06-26 |