| NPI | 1124323712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 038858-1) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: HI PT-3025) |
| Enumeration Date | 2011-01-13 |
| Last Update Date | 2017-06-13 |