| NPI | 1871149179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305213391) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT014162) |
| Enumeration Date | 2019-08-13 |
| Last Update Date | 2021-01-18 |