| NPI | 1164024014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305213941) |
| Enumeration Date | 2020-11-14 |
| Last Update Date | 2023-01-30 |