| NPI | 1477119568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: VA 2305212741) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2019-05-14 |
| Last Update Date | 2021-12-24 |