| NPI | 1326538679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305215553) |
| Additional Taxonomies | 222Q00000X Developmental Therapist |
| Enumeration Date | 2018-05-12 |
| Last Update Date | 2026-05-13 |