| NPI | 1043271836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DC PT870722) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305003259) |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2019-03-20 |