| NPI | 1629010160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305003964) |
| Additional Taxonomies | 174400000X Specialist (Licence: VA 2305003964) |
| Enumeration Date | 2006-06-11 |
| Last Update Date | 2021-04-07 |