| NPI | 1457321911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 0138961) |
| Additional Taxonomies | 2251H1200X Physical Therapist, Hand (Licence: NY 0138961) |
| 2251S0007X Physical Therapist, Sports (Licence: NY 0138961) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: NY 0138961) | |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2008-03-18 |