| NPI | 1639285265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AR PT2449) |
| Additional Taxonomies | 2251P0200X Physical Therapist, Pediatrics (Licence: AR PT2449) |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2023-07-19 |