| NPI | 1669944831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 11763) |
| Additional Taxonomies | 2251P0200X Physical Therapist, Pediatrics |
| Enumeration Date | 2018-12-27 |
| Last Update Date | 2025-01-28 |