| NPI | 1891270617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305213774) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 24070) |
| 225100000X Physical Therapist (Licence: DE J1-0003979) | |
| Enumeration Date | 2018-09-27 |
| Last Update Date | 2021-09-01 |