| NPI | 1285391599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA CP026428T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 28732) |
| Enumeration Date | 2021-11-22 |
| Last Update Date | 2024-01-04 |