| NPI | 1861563694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: SC 4856) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: NY 014253-1) |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2013-11-12 |