| NPI | 1083869622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 022842-1) |
| Additional Taxonomies | 2251P0200X Physical Therapist Pediatrics (Licence: NY 022842-1) |
| 226300000X Kinesiotherapist (Licence: NY 022842-1) | |
| Enumeration Date | 2008-11-24 |
| Last Update Date | 2014-05-02 |