| NPI | 1003971508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 16518) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 025585) |
| Enumeration Date | 2006-12-26 |
| Last Update Date | 2017-05-11 |