| NPI | 1033236229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 013040) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 013040-1) |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2009-05-18 |