| NPI | 1619278892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P13698) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 033230-1) |
| Enumeration Date | 2010-11-04 |
| Last Update Date | 2015-09-14 |