| NPI | 1447389549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 14670) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 0260751) |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2014-07-03 |