| NPI | 1922594597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251P0200X Physical Therapist, Pediatrics (Licence: FL PTT33719) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PTT33719) |
| Enumeration Date | 2018-07-07 |
| Last Update Date | 2023-05-09 |