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 |