| NPI | 1225494115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251P0200X Physical Therapist Pediatrics (Licence: NY 039706) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 039706) |
| Enumeration Date | 2016-01-07 |
| Last Update Date | 2021-08-11 |