| NPI | 1588054522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305212978) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT 29972) |
| Enumeration Date | 2015-01-29 |
| Last Update Date | 2023-03-29 |