| NPI | 1902120348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: FL PT 22248) |
| Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics (Licence: FL PT 22248) |
| 2251G0304X Physical Therapist, Geriatrics (Licence: NY 026828) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: NY 026828) | |
| Enumeration Date | 2010-03-14 |
| Last Update Date | 2012-05-30 |