| NPI | 1376972240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 14947) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 035670) |
| Enumeration Date | 2013-11-01 |
| Last Update Date | 2014-07-07 |