| NPI | 1942604749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 038690-1) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY P95134) |
| Enumeration Date | 2014-10-22 |
| Last Update Date | 2017-01-26 |