| NPI | 1417976689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 028339) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: PA 013146) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2013-09-24 |