| NPI | 1235855958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 29321) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DC 210002187) |
| 225100000X Physical Therapist (Licence: VA 2305215064) | |
| 225100000X Physical Therapist | |
| Enumeration Date | 2022-10-14 |
| Last Update Date | 2025-06-06 |