| NPI | 1043288236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 015652-1) |
| Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics (Licence: NY 015652-1) |
| 2251P0200X Physical Therapist, Pediatrics (Licence: NY 015652-1) | |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2007-07-08 |