| NPI | 1659619294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 10117) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 035225) |
| Enumeration Date | 2013-01-16 |
| Last Update Date | 2014-06-25 |