| NPI | 1801298807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 034918) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 01085) |
| 225100000X Physical Therapist (Licence: PA PT023952) | |
| Enumeration Date | 2014-09-22 |
| Last Update Date | 2014-09-22 |