| NPI | 1639501018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251P0200X Physical Therapist, Pediatrics (Licence: AZ 10467) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 10467) |
| Enumeration Date | 2013-08-07 |
| Last Update Date | 2018-11-28 |