| NPI | 1043548530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171W00000X Contractor (Licence: FL PT26280) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 032052) |
| Enumeration Date | 2009-11-23 |
| Last Update Date | 2011-09-12 |