| NPI | 1427834969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID 8472) |
| Additional Taxonomies | 2251P0200X Physical Therapist, Pediatrics (Licence: ID 8472) |
| Enumeration Date | 2023-08-31 |
| Last Update Date | 2024-08-01 |