| NPI | 1366796336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 036221) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY P86190) |
| Enumeration Date | 2012-10-30 |
| Last Update Date | 2018-10-30 |