| NPI | 1457013609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 047846) |
| Additional Taxonomies | 2251P0200X Physical Therapist Pediatrics |
| Enumeration Date | 2021-10-05 |
| Last Update Date | 2021-11-08 |