| NPI | 1780863027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 028696) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: NY 028696) |
| Enumeration Date | 2007-11-02 |
| Last Update Date | 2015-08-13 |