| NPI | 1376982165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy |
| Additional Taxonomies | 2251P0200X Physical Therapist, Pediatrics (Licence: TX 1221667) |
| Enumeration Date | 2013-06-14 |
| Last Update Date | 2020-11-02 |