| NPI | 1306045190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT 23429) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 8708) |
| Enumeration Date | 2007-07-12 |
| Last Update Date | 2007-07-12 |