| NPI | 1225683808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251P0200X Physical Therapist, Pediatrics |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AR PT4666) |
| Enumeration Date | 2019-08-09 |
| Last Update Date | 2023-10-18 |