| NPI | 1316283450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WY 1791) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305207831) |
| Enumeration Date | 2012-12-18 |
| Last Update Date | 2020-02-10 |