| NPI | 1548790868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251P0200X Physical Therapist, Pediatrics (Licence: NV 3572) |
| Additional Taxonomies | 2251P0200X Physical Therapist, Pediatrics (Licence: CO PTL-0014913) |
| Enumeration Date | 2017-06-19 |
| Last Update Date | 2023-06-05 |