| NPI | 1154862985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305210535) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ND 2072) |
| Enumeration Date | 2017-03-13 |
| Last Update Date | 2022-03-29 |