| NPI | 1043208325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 0028321) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 5562) |
| Enumeration Date | 2005-10-11 |
| Last Update Date | 2012-12-20 |