| NPI | 1952451601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 013221) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 013221-1) |
| Enumeration Date | 2007-01-12 |
| Last Update Date | 2020-06-24 |