| NPI | 1265805980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 15956) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 034037) |
| Enumeration Date | 2015-11-03 |
| Last Update Date | 2018-06-06 |