| NPI | 1295084895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 036869) |
| Additional Taxonomies | 2251C2600X Physical Therapist, Cardiopulmonary (Licence: MA 20205) |
| Enumeration Date | 2012-08-29 |
| Last Update Date | 2019-08-22 |