| NPI | 1962650812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA 020130) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 030586) |
| Enumeration Date | 2008-09-04 |
| Last Update Date | 2010-01-27 |