| NPI | 1295700342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 21811) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 027487) |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2019-05-15 |