| NPI | 1518995489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305204714) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305000941) |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2022-10-06 |