| NPI | 1013072131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT26909) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 025894-1) |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2012-06-19 |