| NPI | 1992376867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305216017) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2021-07-01 |
| Last Update Date | 2025-06-05 |