| NPI | 1841830221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305208154) |
| Additional Taxonomies | 2251G0304X Physical Therapist, Geriatrics (Licence: VA 2305208154) |
| 2251S0007X Physical Therapist, Sports (Licence: VA 2305208154) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: VA 2305208154) | |
| Enumeration Date | 2020-01-13 |
| Last Update Date | 2023-09-06 |