| NPI | 1316403074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251P0200X Physical Therapist Pediatrics (Licence: WA PT61389435) |
| Additional Taxonomies | 2251P0200X Physical Therapist Pediatrics (Licence: CA 300182) |
| 2251P0200X Physical Therapist Pediatrics (Licence: TX 1315122) | |
| Enumeration Date | 2019-02-18 |
| Last Update Date | 2023-11-13 |