| 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 |