| NPI | 1245289586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251G0304X Physical Therapist, Geriatrics (Licence: NY 014926-1) |
| Additional Taxonomies | 2251P0200X Physical Therapist, Pediatrics (Licence: NY 014926-1) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2007-07-08 |