| NPI | 1134291107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251P0200X Physical Therapist, Pediatrics (Licence: MO 101805) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 101805) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2024-10-25 |