| NPI | 1164727897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 030922) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 62030922) |
| Enumeration Date | 2011-01-11 |
| Last Update Date | 2016-04-13 |