| NPI | 1174768501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 028645) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: NY 028645-1) |
| Enumeration Date | 2008-12-15 |
| Last Update Date | 2012-03-29 |