| NPI | 1093362600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 27638) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305215619) |
| Enumeration Date | 2019-08-20 |
| Last Update Date | 2025-02-20 |