| NPI | 1215984133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH5065) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 025863) |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2011-11-10 |