| NPI | 1265521702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 3951) |
| Additional Taxonomies | 2251N0400X Physical Therapist, Neurology (Licence: AZ 3951) |
| 2251P0200X Physical Therapist, Pediatrics (Licence: AZ 3951) | |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2007-07-08 |