| NPI | 1427481662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 036245) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT022881) |
| 225100000X Physical Therapist (Licence: NJ 40QA01521300) | |
| 225100000X Physical Therapist (Licence: CA PT41018) | |
| 225100000X Physical Therapist (Licence: FL PT29018) | |
| Enumeration Date | 2013-08-12 |
| Last Update Date | 2014-03-31 |