| NPI | 1730404781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT020390) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 030763) |
| Enumeration Date | 2010-04-02 |
| Last Update Date | 2010-04-02 |