| NPI | 1861822389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251P0200X Physical Therapist, Pediatrics (Licence: NY 037285) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 037285) |
| 2251G0304X Physical Therapist, Geriatrics (Licence: NY 037285) | |
| Enumeration Date | 2013-11-19 |
| Last Update Date | 2020-02-19 |