| NPI | 1215997184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305207779) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WY PT1147) |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2014-03-18 |