| NPI | 1336546928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 038378) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 011175) |
| Enumeration Date | 2014-11-25 |
| Last Update Date | 2016-11-29 |