| NPI | 1083051528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305207726) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1226610) |
| Enumeration Date | 2013-05-23 |
| Last Update Date | 2015-04-13 |