| NPI | 1629612429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 27753) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305214077) |
| Enumeration Date | 2019-11-05 |
| Last Update Date | 2021-02-26 |