| NPI | 1962442681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 009705) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 7161) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2019-03-06 |