| NPI | 1396392650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305213112) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 42589) |
| Enumeration Date | 2019-08-21 |
| Last Update Date | 2025-01-15 |