| NPI | 1467740365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251P0200X Physical Therapist Pediatrics (Licence: AL PTH7044) |
| Additional Taxonomies | 2251P0200X Physical Therapist Pediatrics (Licence: FL PT26622) |
| Enumeration Date | 2011-07-13 |
| Last Update Date | 2015-08-10 |