| NPI | 1477841062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 0284561) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT018380) |
| Enumeration Date | 2011-07-15 |
| Last Update Date | 2021-03-08 |