| NPI | 1144459017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: NY 031230-1) |
| Additional Taxonomies | 2251P0200X Physical Therapist Pediatrics (Licence: NY 031230-1) |
| Enumeration Date | 2009-07-13 |
| Last Update Date | 2012-03-05 |