| NPI | 1831791029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305213625) |
| Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics |
| Enumeration Date | 2020-11-12 |
| Last Update Date | 2025-01-20 |