NPI | 1669793980 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2251G0304X Physical Therapist, Geriatrics (Licence: NY 018679-1) |
Additional Taxonomies | 2251P0200X Physical Therapist, Pediatrics (Licence: NY 018679-1) |
Enumeration Date | 2010-06-22 |
Last Update Date | 2010-06-22 |