| NPI | 1902095250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 028627) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05009141A) |
| 225100000X Physical Therapist (Licence: PA PT018549) | |
| 225100000X Physical Therapist (Licence: CT 008080) | |
| Enumeration Date | 2007-10-22 |
| Last Update Date | 2007-10-22 |