| NPI | 1194480137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251P0200X Physical Therapist, Pediatrics (Licence: FL PT37967) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT37967) |
| Enumeration Date | 2021-11-04 |
| Last Update Date | 2024-04-22 |