| NPI | 1629678537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305213860) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT015011) |
| Enumeration Date | 2020-10-29 |
| Last Update Date | 2023-04-13 |