| NPI | 1790297950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 26712) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 8617) |
| 225100000X Physical Therapist (Licence: VA 2305211157) | |
| Enumeration Date | 2017-10-27 |
| Last Update Date | 2024-02-05 |