| NPI | 1295980282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251P0200X Physical Therapist Pediatrics (Licence: NY 012457-1) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 012457-1) |
| 2251G0304X Physical Therapist Geriatrics (Licence: NY 012457-1) | |
| Enumeration Date | 2008-11-18 |
| Last Update Date | 2008-11-18 |