| NPI | 1386011823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 35397) |
| Additional Taxonomies | 2251P0200X Physical Therapist, Pediatrics (Licence: CA 42989) |
| Enumeration Date | 2015-09-01 |
| Last Update Date | 2024-03-01 |