| NPI | 1346672003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 034920) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305207892) |
| Enumeration Date | 2013-08-05 |
| Last Update Date | 2013-08-05 |