| NPI | 1750363545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 9136) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 5065) |
| Enumeration Date | 2005-11-16 |
| Last Update Date | 2007-07-08 |