| NPI | 1932754397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305215901) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT027982) |
| Enumeration Date | 2019-08-02 |
| Last Update Date | 2023-09-25 |