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 |