| NPI | 1851908628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305216591) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 26045) |
| Enumeration Date | 2020-09-25 |
| Last Update Date | 2025-04-14 |