| NPI | 1457651499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 012768-1) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 8786) |
| Enumeration Date | 2010-10-25 |
| Last Update Date | 2018-01-05 |