| NPI | 1033568241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA 60974773) |
| Additional Taxonomies | 225XP0200X Occupational Therapist, Pediatrics (Licence: KY 168153) |
| Enumeration Date | 2016-06-08 |
| Last Update Date | 2023-09-11 |