| NPI | 1770168395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305214192) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT029327) |
| Enumeration Date | 2021-03-15 |
| Last Update Date | 2021-11-20 |