| NPI | 1497291769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305210849) |
| Enumeration Date | 2017-01-11 |
| Last Update Date | 2026-06-18 |