| NPI | 1194105189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VT 040.0121580) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2015-06-04 |
| Last Update Date | 2020-11-04 |