| NPI | 1063665958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 11845) |
| Additional Taxonomies | 2251P0200X Physical Therapist, Pediatrics (Licence: NC 11845) |
| Enumeration Date | 2008-10-23 |
| Last Update Date | 2020-02-25 |