| NPI | 1184865644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 034831-1) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: RI PT02204) |
| 225100000X Physical Therapist (Licence: PA PT021076) | |
| Enumeration Date | 2009-03-13 |
| Last Update Date | 2015-09-24 |