| NPI | 1609765783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305217286) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2025-07-02 |
| Last Update Date | 2025-08-07 |