| NPI | 1255338133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 017798-1) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT008075) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2009-05-29 |