| NPI | 1750607925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251P0200X Physical Therapist, Pediatrics (Licence: CA 13751) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 13751) |
| Enumeration Date | 2010-04-13 |
| Last Update Date | 2010-04-13 |