| NPI | 1871040279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305212458) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 12491) |
| Enumeration Date | 2016-09-02 |
| Last Update Date | 2021-07-16 |