| NPI | 1245768548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251P0200X Physical Therapist, Pediatrics (Licence: TX 1294505) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2017-05-31 |
| Last Update Date | 2018-04-27 |