| NPI | 1679720411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 029612-1) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT019387) |
| 225100000X Physical Therapist (Licence: HI 2798) | |
| Enumeration Date | 2008-08-23 |
| Last Update Date | 2010-02-08 |