| NPI | 1922781277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA CP024496T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 29565) |
| Enumeration Date | 2023-08-11 |
| Last Update Date | 2023-10-23 |