| NPI | 1649779075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305214492) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 26869) |
| Enumeration Date | 2018-02-12 |
| Last Update Date | 2021-10-26 |