| NPI | 1679946750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 038034-1) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT024806) |
| 225100000X Physical Therapist (Licence: ZZ 0019900) | |
| Enumeration Date | 2015-11-11 |
| Last Update Date | 2015-11-11 |