| NPI | 1972874790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT27376) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 032730) |
| Enumeration Date | 2012-01-25 |
| Last Update Date | 2017-02-22 |