| NPI | 1063729077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 23087) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA CP044429T) |
| Enumeration Date | 2010-09-13 |
| Last Update Date | 2025-05-27 |