| NPI | 1619576055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305215438) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC P19913) |
| Enumeration Date | 2020-10-17 |
| Last Update Date | 2023-10-06 |