| NPI | 1144605783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305204823) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DC PT870097) |
| 225100000X Physical Therapist (Licence: MD 22265) | |
| Enumeration Date | 2015-07-24 |
| Last Update Date | 2016-02-15 |