| NPI | 1386071470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 11316) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 036874-1) |
| Enumeration Date | 2013-10-03 |
| Last Update Date | 2018-03-17 |