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 |