| NPI | 1053379925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305206734) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NH 3037) |
| Enumeration Date | 2006-05-02 |
| Last Update Date | 2022-05-12 |