| NPI | 1750532040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251P0200X Physical Therapist, Pediatrics (Licence: NY 019097-1) |
| Additional Taxonomies | 171W00000X Contractor (Licence: NY 019097-1) |
| Enumeration Date | 2008-10-04 |
| Last Update Date | 2008-11-13 |