| NPI | 1417248279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT020929) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 033021) |
| Enumeration Date | 2011-04-28 |
| Last Update Date | 2013-07-23 |