| NPI | 1225282114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 027630) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT018016) |
| Enumeration Date | 2008-11-05 |
| Last Update Date | 2008-11-05 |