| NPI | 1245586338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251P0200X Physical Therapist, Pediatrics (Licence: SC 6798) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P13800) |
| Enumeration Date | 2012-07-26 |
| Last Update Date | 2012-07-27 |