| NPI | 1275870966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305208067) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 25068) |
| Enumeration Date | 2013-01-15 |
| Last Update Date | 2022-03-11 |