| NPI | 1235689357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251P0200X Physical Therapist, Pediatrics (Licence: PA PT026482) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501017726) |
| Enumeration Date | 2016-10-12 |
| Last Update Date | 2018-08-22 |