| NPI | 1750821294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 038469-1) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA pt024154) |
| Enumeration Date | 2017-03-02 |
| Last Update Date | 2017-03-02 |