| NPI | 1437515350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 039458) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT31125) |
| Enumeration Date | 2016-01-07 |
| Last Update Date | 2016-04-11 |