| NPI | 1174774822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305216399) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 5786) |
| Enumeration Date | 2008-09-30 |
| Last Update Date | 2024-09-05 |