| NPI | 1962642108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 026434) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: NY CO004619) |
| Enumeration Date | 2009-02-28 |
| Last Update Date | 2018-10-24 |