| NPI | 1174350540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305212167) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT33993) |
| Enumeration Date | 2024-09-18 |
| Last Update Date | 2024-09-18 |