| NPI | 1871626325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 022228-1) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: NY 022228) |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2009-09-11 |