| NPI | 1558369199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: NY 0229891) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: VA 2305203001) |
| Enumeration Date | 2005-07-08 |
| Last Update Date | 2009-12-22 |