| NPI | 1659960904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: VA 2305214111) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 12191) |
| Enumeration Date | 2021-01-12 |
| Last Update Date | 2024-01-25 |