| NPI | 1699870204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 011600) |
| Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics (Licence: NY 011600) |
| 2251H1300X Physical Therapist, Human Factors (Licence: NY 011600) | |
| 2251P0200X Physical Therapist, Pediatrics (Licence: NY 011600) | |
| 2251S0007X Physical Therapist, Sports (Licence: NY 011600) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: NY 011600) | |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2007-07-08 |