| NPI | 1497830970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY PT025941) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT017025) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2008-02-15 |