| NPI | 1750687901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 9420) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 7329920) |
| Enumeration Date | 2011-02-07 |
| Last Update Date | 2015-03-19 |