| NPI | 1952404212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2355S0801X Specialist/Technologist, Speech-Language Assistant |
| Additional Taxonomies | 222Q00000X Developmental Therapist |
| 225100000X Physical Therapist | |
| 2251P0200X Physical Therapist, Pediatrics | |
| Enumeration Date | 2006-09-05 |
| Last Update Date | 2010-03-02 |