| NPI | 1578093845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305211075) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P-CP003911T) |
| Enumeration Date | 2017-06-19 |
| Last Update Date | 2024-06-18 |