| NPI | 1699457374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA CP022630T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 29365) |
| Enumeration Date | 2023-08-02 |
| Last Update Date | 2023-08-02 |