| NPI | 1407284714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305208494) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: VA 0121001206) |
| 225100000X Physical Therapist (Licence: MD 24747) | |
| Enumeration Date | 2013-10-23 |
| Last Update Date | 2025-05-01 |