| NPI | 1871655001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 6888) |
| Additional Taxonomies | 2251P0200X Physical Therapist, Pediatrics (Licence: AZ 6888) |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2007-07-09 |