| NPI | 1619098738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 0310961) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 10126) |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2010-06-13 |