| NPI | 1710923776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 23052140442) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT003818L) |
| Enumeration Date | 2006-06-20 |
| Last Update Date | 2020-12-31 |