| NPI | 1720818578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305216794) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 30067) |
| Enumeration Date | 2024-08-06 |
| Last Update Date | 2025-01-15 |