| NPI | 1124336995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251P0200X Physical Therapist, Pediatrics (Licence: ND 2236) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 032846-1) |
| Enumeration Date | 2010-09-15 |
| Last Update Date | 2024-12-05 |