| NPI | 1396883369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 19563) |
| Additional Taxonomies | 2251C2600X (Licence: MD 19563) |
| 2251P0200X Physical Therapist, Pediatrics (Licence: MD 19563) | |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2014-05-08 |