| NPI | 1982609541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305202501) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 19525) |
| Enumeration Date | 2005-06-20 |
| Last Update Date | 2023-12-21 |