| NPI | 1801386735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305211889) |
| Enumeration Date | 2018-05-16 |
| Last Update Date | 2020-12-03 |