Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 031534 | NY |
NPI | 1003045881 |
---|---|
Provider Name | Steven Gonser |
First Address | Buffalo, NY 14267-0002 |
Second Address | Tonawanda, NY 14150-5547 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2009 |
Last Update Date | 14/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03173237 | (05) | NY |