| NPI | 1194124230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 037970) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P15173) |
| Enumeration Date | 2014-08-14 |
| Last Update Date | 2014-08-14 |