| NPI | 1316297369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305207785) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 13774) |
| Enumeration Date | 2012-09-18 |
| Last Update Date | 2023-11-03 |