| NPI | 1043965098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 30357) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305214832) |
| Enumeration Date | 2022-02-18 |
| Last Update Date | 2025-05-02 |