| NPI | 1821032319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251G0304X Physical Therapist, Geriatrics (Licence: VA 2305212726) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: VA 2305212726) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2025-04-03 |