| NPI | 1497329668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305214280) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN CP018291T) |
| Enumeration Date | 2021-05-13 |
| Last Update Date | 2025-01-09 |