| NPI | 1174260533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD cp037258T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305209103) |
| Enumeration Date | 2022-05-17 |
| Last Update Date | 2024-11-21 |