| NPI | 1790964799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251P0200X Physical Therapist, Pediatrics (Licence: KY 005036) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY 005036) |
| Enumeration Date | 2007-10-26 |
| Last Update Date | 2008-02-21 |