| NPI | 1407371404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MS PT6335) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 042467) |
| Enumeration Date | 2017-08-10 |
| Last Update Date | 2018-06-16 |