| NPI | 1962632059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 028902-1) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 22294) |
| Enumeration Date | 2009-07-22 |
| Last Update Date | 2009-07-22 |