| NPI | 1730495607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305216590) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OK 4231) |
| Enumeration Date | 2010-08-29 |
| Last Update Date | 2024-09-19 |