| NPI | 1821053232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 018804-1) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 018804) |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2016-10-01 |