| NPI | 1275869737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: MD 22381) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 029621-1) |
| Enumeration Date | 2009-10-19 |
| Last Update Date | 2009-10-19 |