| NPI | 1003948381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: NY 025232) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 22125) |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2008-02-04 |