| NPI | 1790010353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 032480) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NY 006517) |
| Enumeration Date | 2009-10-14 |
| Last Update Date | 2010-05-20 |