| NPI | 1417703588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305216368) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2024-04-29 |
| Last Update Date | 2024-05-16 |