| NPI | 1225317274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 6653) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305207813) |
| 225100000X Physical Therapist (Licence: NC P12796) | |
| Enumeration Date | 2011-08-09 |
| Last Update Date | 2018-07-23 |