| NPI | 1538282454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 028158) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 27337) |
| Enumeration Date | 2007-04-07 |
| Last Update Date | 2013-02-07 |