| NPI | 1538466487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251P0200X Physical Therapist, Pediatrics (Licence: NY 019367-1) |
| Additional Taxonomies | 2251N0400X Physical Therapist, Neurology (Licence: NY 019367-1) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: NY 019367-1) | |
| Enumeration Date | 2011-02-11 |
| Last Update Date | 2011-02-11 |