| NPI | 1366877425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NM 4830) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 036413) |
| Enumeration Date | 2013-09-09 |
| Last Update Date | 2016-06-01 |