| NPI | 1952035289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA CP007774T) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist (Licence: MS PT7190) | |
| Enumeration Date | 2022-07-12 |
| Last Update Date | 2022-08-16 |