| NPI | 1326793316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251P0200X Physical Therapist, Pediatrics (Licence: WV 4381) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WV PT004381) |
| Enumeration Date | 2022-02-17 |
| Last Update Date | 2026-04-16 |