| NPI | 1932977329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251P0200X Physical Therapist, Pediatrics (Licence: NV 6321) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 6321) |
| Enumeration Date | 2023-12-14 |
| Last Update Date | 2026-05-14 |