| NPI | 1740509769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251P0200X Physical Therapist, Pediatrics (Licence: MD 24412) |
| Additional Taxonomies | 2251P0200X Physical Therapist, Pediatrics (Licence: PA PT 020542) |
| Enumeration Date | 2010-06-01 |
| Last Update Date | 2013-03-20 |