| NPI | 1093095911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251P0200X Physical Therapist Pediatrics (Licence: PA PT011962L) |
| Additional Taxonomies | 2251P0200X Physical Therapist Pediatrics (Licence: NJ 40QA01276100) |
| Enumeration Date | 2011-08-23 |
| Last Update Date | 2011-08-23 |