| NPI | 1396847414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 008038) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 62 014054) |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2011-04-13 |