| NPI | 1760648810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305214728) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 12069-24) |
| 225100000X Physical Therapist (Licence: IL 070-016509) | |
| Enumeration Date | 2008-07-29 |
| Last Update Date | 2022-11-21 |