| NPI | 1962279638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305216605) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2023-12-04 |
| Last Update Date | 2024-10-22 |