| NPI | 1407074693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251P0200X Physical Therapist, Pediatrics (Licence: IL 070012822) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070012822) |
| 225100000X Physical Therapist (Licence: IN 05007676A) | |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2015-10-15 |