| NPI | 1386803930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251P0200X Physical Therapist Pediatrics (Licence: TX 1079218) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1079218) |
| Enumeration Date | 2008-06-07 |
| Last Update Date | 2023-07-25 |