| NPI | 1902175839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT27237) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 034550) |
| Enumeration Date | 2011-12-21 |
| Last Update Date | 2016-03-18 |