| NPI | 1639412661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 034180) |
| Additional Taxonomies | 133NN1002X Nutritionist, Nutrition, Education |
| 133N00000X Nutritionist | |
| 2251G0304X Physical Therapist, Geriatrics (Licence: NY 034180) | |
| 2251N0400X Physical Therapist, Neurology (Licence: NY 034180) | |
| 2251P0200X Physical Therapist, Pediatrics (Licence: NY 034180) | |
| 2251S0007X Physical Therapist, Sports (Licence: NY 034180) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: NY 034180) | |
| Enumeration Date | 2013-03-27 |
| Last Update Date | 2013-03-27 |