| NPI | 1942011994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251P0200X Physical Therapist, Pediatrics (Licence: IN 05013150A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: 05013150A) |
| Enumeration Date | 2025-01-17 |
| Last Update Date | 2025-01-17 |