| NPI | 1104055045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT-26998) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 043062) |
| Enumeration Date | 2009-07-14 |
| Last Update Date | 2018-11-16 |