| NPI | 1023486800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 25663) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305209702) |
| Enumeration Date | 2015-09-09 |
| Last Update Date | 2018-12-28 |