| NPI | 1568823268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305211830) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 25851) |
| Enumeration Date | 2016-03-09 |
| Last Update Date | 2023-01-11 |