| NPI | 1932362977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: MT 0) |
| Additional Taxonomies | 225XP0200X Occupational Therapist Pediatrics (Licence: MT 550) |
| Enumeration Date | 2008-07-09 |
| Last Update Date | 2008-07-09 |