| NPI | 1255396677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 022005-1) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P8287) |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2013-12-12 |