| NPI | 1972719870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251P0200X Physical Therapist, Pediatrics (Licence: NH 2622) |
| Additional Taxonomies | 2251P0200X Physical Therapist, Pediatrics (Licence: MA 11594) |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2007-07-08 |