| NPI | 1013963735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251P0200X Physical Therapist, Pediatrics (Licence: NY 016320) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 016320-1) |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2011-03-22 |