| NPI | 1245679281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305207948) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 24512) |
| Enumeration Date | 2013-06-24 |
| Last Update Date | 2018-05-04 |