| NPI | 1649202334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251P0200X Physical Therapist, Pediatrics (Licence: WI 1517-024) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: WI 1517-024) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2007-07-08 |