| NPI | 1548320377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 22339) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 028862) |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2010-10-21 |