| NPI | 1003365339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305211583) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 26044) |
| Enumeration Date | 2016-09-28 |
| Last Update Date | 2020-01-31 |