| NPI | 1013226182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251P0200X Physical Therapist, Pediatrics (Licence: AZ 9085) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: AZ 9085) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: AZ 9085) | |
| Enumeration Date | 2010-10-06 |
| Last Update Date | 2010-10-06 |