| NPI | 1962787994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 014151) |
| Additional Taxonomies | 2251G0304X Physical Therapist Geriatrics (Licence: NY 014151) |
| 2251S0007X Physical Therapist Sports (Licence: NY 014151) | |
| 2251X0800X Physical Therapist Orthopedic (Licence: NY 014151) | |
| 2251X0800X Physical Therapist Orthopedic (Licence: PA PT007930L) | |
| 2251S0007X Physical Therapist Sports (Licence: PA PT007930L) | |
| Enumeration Date | 2011-10-21 |
| Last Update Date | 2013-06-18 |