| NPI | 1295896553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: VA 2305006240) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 291422) |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2019-03-27 |