Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics |
NPI | 1396943577 |
---|---|
Provider Name | Boris Khotylev |
First Address | Brooklyn, NY 11235-3648 |
Second Address | Brooklyn, NY 11214-5033 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2007 |
Last Update Date | 05/08/2015 |