| NPI | 1780977124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 030968) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA pt021235) |
| Enumeration Date | 2011-05-18 |
| Last Update Date | 2011-05-18 |