| NPI | 1043541972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 25086) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 032241) |
| Enumeration Date | 2010-01-15 |
| Last Update Date | 2018-03-17 |