| NPI | 1750959995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305215239) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD CP015186T) |
| Enumeration Date | 2021-06-15 |
| Last Update Date | 2024-03-15 |