| NPI | 1972928547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 24923) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305208517) |
| Enumeration Date | 2014-02-19 |
| Last Update Date | 2024-03-11 |