| NPI | 1720413784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 24735) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 036727) |
| Enumeration Date | 2013-09-10 |
| Last Update Date | 2015-08-27 |