| NPI | 1245513191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 028169) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 034341-1) |
| Enumeration Date | 2011-09-27 |
| Last Update Date | 2013-04-16 |