NPI | 1801046644 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: NY 025725) |
Additional Taxonomies | 2251P0200X Physical Therapist, Pediatrics (Licence: NY 025725) |
Enumeration Date | 2008-09-29 |
Last Update Date | 2011-12-21 |