| NPI | 1245937739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA CP035191T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 29332) |
| Enumeration Date | 2023-02-14 |
| Last Update Date | 2024-10-17 |