| NPI | 1861961443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305212269) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2018-11-13 |
| Last Update Date | 2020-09-12 |