| NPI | 1558831966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251P0200X Physical Therapist Pediatrics (Licence: SC 9238) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 9238) |
| Enumeration Date | 2018-11-28 |
| Last Update Date | 2025-06-27 |