| NPI | 1225683808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO CP034808T) |
| Additional Taxonomies | 2251P0200X Physical Therapist, Pediatrics |
| 225100000X Physical Therapist (Licence: AR PT4666) | |
| Enumeration Date | 2019-08-09 |
| Last Update Date | 2024-12-23 |