| NPI | 1255364220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT 6466) |
| Additional Taxonomies | 2251E1300X Physical Therapist Electrophysiology, Clinical (Licence: NY PT 8986) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2010-08-23 |