| NPI | 1538291430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 3091) |
| Additional Taxonomies | 2251P0200X Physical Therapist Pediatrics (Licence: AZ 3091) |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2007-07-08 |