| NPI | 1134488448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 12069) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 034971) |
| Enumeration Date | 2012-05-07 |
| Last Update Date | 2019-03-06 |