| NPI | 1497091250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: HI PT-3997) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: NY 007638) |
| Enumeration Date | 2012-12-26 |
| Last Update Date | 2016-06-01 |