| NPI | 1811352768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 038653) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 10663) |
| Enumeration Date | 2015-12-19 |
| Last Update Date | 2015-12-19 |