| NPI | 1447626601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 039268-1) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY 006693) |
| Enumeration Date | 2015-08-11 |
| Last Update Date | 2015-08-11 |