| NPI | 1902097264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 029068) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05009211A) |
| Enumeration Date | 2007-08-01 |
| Last Update Date | 2018-07-19 |