| NPI | 1134470677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 13998-24) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 62034868) |
| Enumeration Date | 2012-09-24 |
| Last Update Date | 2018-02-09 |