| NPI | 1457784381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251P0200X Physical Therapist, Pediatrics (Licence: CA 39876) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 39876) |
| Enumeration Date | 2013-08-14 |
| Last Update Date | 2026-07-28 |