| NPI | 1629134689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305205251) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 20662) |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2024-02-12 |