| NPI | 1366824617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 039289) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY P97662) |
| Enumeration Date | 2015-06-23 |
| Last Update Date | 2016-04-05 |