| NPI | 1952855785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 2251P0200X Physical Therapist Pediatrics (Licence: AR 4234) |
| Enumeration Date | 2016-08-10 |
| Last Update Date | 2024-09-16 |