| NPI | 1184313074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA CP029380T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 29413) |
| Enumeration Date | 2023-05-05 |
| Last Update Date | 2025-06-17 |