| NPI | 1083946925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05009859A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 031369) |
| Enumeration Date | 2010-02-03 |
| Last Update Date | 2010-02-03 |