| NPI | 1164671947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251P0200X Physical Therapist, Pediatrics (Licence: NY 019910) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2008-09-16 |
| Last Update Date | 2008-09-16 |