| NPI | 1881974038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA 022216) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 033566) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NY 001937) | |
| Enumeration Date | 2011-08-19 |
| Last Update Date | 2012-09-18 |