| NPI | 1053367292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT026630) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 006561-1) |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2018-03-13 |