| NPI | 1467008136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 0119008241) |
| Additional Taxonomies | 225XH1200X Occupational Therapist Hand (Licence: VA 0119-008241) |
| Enumeration Date | 2019-08-17 |
| Last Update Date | 2024-02-05 |