| NPI | 1003283508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VT 040.0112798) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2015-09-01 |
| Last Update Date | 2018-04-18 |