| NPI | 1346623592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251P0200X Physical Therapist, Pediatrics (Licence: NY 62 039569) |
| Additional Taxonomies | 2251P0200X Physical Therapist, Pediatrics (Licence: NY P97597) |
| Enumeration Date | 2015-07-07 |
| Last Update Date | 2015-11-19 |