| NPI | 1144748013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 26482) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305210909) |
| Enumeration Date | 2017-08-31 |
| Last Update Date | 2022-07-22 |