| NPI | 1316588320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305216988) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2019-10-01 |
| Last Update Date | 2025-06-10 |