| NPI | 1992790497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 004246-1) |
| Additional Taxonomies | 174400000X Specialist (Licence: NY 0042461) |
| Enumeration Date | 2005-09-12 |
| Last Update Date | 2011-05-03 |