| NPI | 1053663765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 032965) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501015319) |
| 225100000X Physical Therapist (Licence: PA PT021795) | |
| Enumeration Date | 2012-10-04 |
| Last Update Date | 2012-10-04 |