| NPI | 1871647388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 031325-1) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 011278) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2016-10-13 |