| NPI | 1811465214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305216800) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 11925) |
| Enumeration Date | 2018-11-05 |
| Last Update Date | 2024-12-24 |