| NPI | 1598769085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 6597) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 020670) |
| 225100000X Physical Therapist (Licence: NC 13551) | |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2015-01-20 |