| NPI | 1386280162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305212976) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT014513) |
| Enumeration Date | 2019-11-27 |
| Last Update Date | 2021-03-05 |