| NPI | 1629053194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 019101-1) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 25891) |
| Enumeration Date | 2005-12-07 |
| Last Update Date | 2008-08-20 |