| NPI | 1477954485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305213243) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 2251X0800X Physical Therapist, Orthopedic (Licence: VA 2305213243) | |
| Enumeration Date | 2014-09-09 |
| Last Update Date | 2025-06-30 |