| NPI | 1295702561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 011854) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT-007374-L) |
| Enumeration Date | 2006-03-03 |
| Last Update Date | 2007-07-08 |