| NPI | 1942295407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 022084) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 12021) |
| Enumeration Date | 2005-09-12 |
| Last Update Date | 2018-12-12 |