| NPI | 1720102254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: NY 2909) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 010113-1) |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2007-07-08 |