| NPI | 1144774852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305211723) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60721848) |
| 225100000X Physical Therapist (Licence: OH PT016271) | |
| Enumeration Date | 2016-08-10 |
| Last Update Date | 2018-03-26 |