| NPI | 1568518769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 016311-1) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: NY 016311-1) |
| Enumeration Date | 2007-01-28 |
| Last Update Date | 2012-06-21 |