| NPI | 1811161169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner (Licence: NY 030139-1) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 030139) |
| Enumeration Date | 2008-04-17 |
| Last Update Date | 2020-04-21 |