| NPI | 1801957592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251P0200X Physical Therapist, Pediatrics (Licence: IN 05002904A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05002904A) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2025-09-11 |