| NPI | 1164446449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 10961) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 012378) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2016-11-16 |