| NPI | 1255778924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305207799) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 23139) |
| Enumeration Date | 2013-06-04 |
| Last Update Date | 2023-09-14 |