| NPI | 1396950291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 8816) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: HI 3181) |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2011-11-08 |