| NPI | 1790209211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305211332) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2017-07-26 |
| Last Update Date | 2023-09-15 |