| NPI | 1538652391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305211959) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 9176) |
| Enumeration Date | 2018-06-07 |
| Last Update Date | 2020-08-11 |