| NPI | 1902423700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305213736) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2020-06-29 |
| Last Update Date | 2023-05-09 |