| NPI | 1790715266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 014195-1) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 007465) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2007-07-08 |