| NPI | 1114167871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NY 023679) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 023679) |
| Enumeration Date | 2009-02-20 |
| Last Update Date | 2009-12-08 |