| NPI | 1831610534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251P0200X Physical Therapist Pediatrics (Licence: DE J1-0003770) |
| Additional Taxonomies | 2251P0200X Physical Therapist Pediatrics |
| Enumeration Date | 2017-07-03 |
| Last Update Date | 2018-12-07 |