| NPI | 1184688780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 027285) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 200528295) |
| Enumeration Date | 2006-04-12 |
| Last Update Date | 2014-05-26 |