| NPI | 1083054977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 039339) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NY 008541) |
| Enumeration Date | 2013-06-25 |
| Last Update Date | 2015-08-12 |