| NPI | 1063245538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA CP042699T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL 57045) |
| Enumeration Date | 2024-08-21 |
| Last Update Date | 2025-03-20 |