| NPI | 1275907057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DC PT871891) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305209801) |
| Enumeration Date | 2015-11-17 |
| Last Update Date | 2016-01-18 |