| NPI | 1609979756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305004218) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 7134) |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2023-09-08 |