| NPI | 1245327105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 0195371) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 8998) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2016-08-18 |