| NPI | 1114462686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 62 040871) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT024017) |
| Enumeration Date | 2016-12-19 |
| Last Update Date | 2019-06-13 |