| NPI | 1295855625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 20696) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305204688) |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2025-04-15 |