| NPI | 1568918456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251P0200X Physical Therapist, Pediatrics (Licence: DE J1-0002776) |
| Additional Taxonomies | 2251P0200X Physical Therapist, Pediatrics (Licence: PA PT022802) |
| Enumeration Date | 2016-08-30 |
| Last Update Date | 2016-08-30 |