| NPI | 1659366177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 1659366177) |
| Additional Taxonomies | 2251P0200X Physical Therapist, Pediatrics (Licence: NY 244141) |
| Enumeration Date | 2005-09-12 |
| Last Update Date | 2022-01-12 |