| NPI | 1194100578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA CP014507T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2015017637) |
| Enumeration Date | 2015-07-27 |
| Last Update Date | 2022-08-25 |