| NPI | 1962160291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VT 040.0134884) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2021-12-03 |
| Last Update Date | 2025-02-05 |