| NPI | 1740479799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 030150) |
| Additional Taxonomies | 171W00000X Contractor (Licence: IN 05008982A) |
| Enumeration Date | 2007-10-16 |
| Last Update Date | 2010-02-25 |