| NPI | 1164573119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305211438) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NM 3236) |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2019-08-06 |