| NPI | 1659676005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 27179) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 033271) |
| Enumeration Date | 2011-01-17 |
| Last Update Date | 2012-02-17 |