| NPI | 1649417650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 023083-1) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 11887) |
| 225100000X Physical Therapist (Licence: CT 008341) | |
| Enumeration Date | 2009-01-13 |
| Last Update Date | 2009-01-13 |