| NPI | 1104343086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305211481) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: VA 2305211481) |
| Enumeration Date | 2017-08-23 |
| Last Update Date | 2022-11-30 |