| NPI | 1407800238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 009696-2) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 5586460001) |
| 2251H1200X Physical Therapist, Hand | |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2018-07-11 |