| NPI | 1730205543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251P0200X Physical Therapist, Pediatrics (Licence: CA PT30379) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT30379) |
| 225100000X Physical Therapist (Licence: MA PT15075) | |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2014-09-25 |