| NPI | 1174904171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: NY 035754) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 2251G0304X Physical Therapist, Geriatrics (Licence: NM 4583) | |
| Enumeration Date | 2015-06-15 |
| Last Update Date | 2015-06-15 |