| NPI | 1649958315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305215919) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: VA 2305215919) |
| 225100000X Physical Therapist | |
| Enumeration Date | 2023-07-11 |
| Last Update Date | 2023-08-21 |