| NPI | 1215459342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 36652) |
| Additional Taxonomies | 2251P0200X Physical Therapist, Pediatrics (Licence: NY 028470) |
| Enumeration Date | 2009-01-05 |
| Last Update Date | 2019-05-28 |