| NPI | 1649390907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 10111) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 017936) |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2019-10-04 |