| NPI | 1013187533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 032656) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT019119) |
| Enumeration Date | 2008-03-12 |
| Last Update Date | 2014-10-14 |