| NPI | 1851035224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305206519) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: VA 2305206519) |
| Enumeration Date | 2022-04-22 |
| Last Update Date | 2022-07-13 |