| NPI | 1245773373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305213748) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 26192) |
| Enumeration Date | 2016-11-21 |
| Last Update Date | 2023-12-28 |