| NPI | 1679357628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305215949) |
| Enumeration Date | 2023-08-22 |
| Last Update Date | 2025-01-31 |