| NPI | 1225324478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 23672) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305207748) |
| Enumeration Date | 2011-06-27 |
| Last Update Date | 2017-01-12 |