| NPI | 1336541952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 2869) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 037298) |
| Enumeration Date | 2014-09-26 |
| Last Update Date | 2014-09-26 |