| NPI | 1235471764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251P0200X Physical Therapist, Pediatrics (Licence: TX 1049179) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1049179) |
| Enumeration Date | 2013-03-22 |
| Last Update Date | 2014-12-12 |