| NPI | 1548712516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251P0200X Physical Therapist, Pediatrics (Licence: ND 1179) |
| Additional Taxonomies | 2251P0200X Physical Therapist, Pediatrics (Licence: SD 1262) |
| Enumeration Date | 2016-10-26 |
| Last Update Date | 2016-10-26 |