| NPI | 1942792064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 2251N0400X Physical Therapist, Neurology |
| 2251P0200X Physical Therapist, Pediatrics | |
| Enumeration Date | 2018-06-04 |
| Last Update Date | 2019-09-11 |