| NPI | 1467765982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251G0304X Physical Therapist, Geriatrics (Licence: NY 017865) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 017865) |
| 2251P0200X Physical Therapist, Pediatrics (Licence: NY 017865) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: NY 017865) | |
| Enumeration Date | 2010-07-26 |
| Last Update Date | 2010-07-26 |