| NPI | 1700913092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 19693) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 026757-1) |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2016-10-20 |