| NPI | 1861043291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305214207) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CT 12463) |
| Enumeration Date | 2019-09-26 |
| Last Update Date | 2021-05-13 |