| NPI | 1083732465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305207222) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA 012806L) |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2023-11-27 |