| NPI | 1891460101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305214622) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2021-08-10 |
| Last Update Date | 2021-09-17 |