| NPI | 1467851295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305212970) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 25153) |
| 174400000X Specialist (Licence: MD 25153) | |
| Enumeration Date | 2014-08-18 |
| Last Update Date | 2025-05-07 |