| NPI | 1316286156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305207025) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT27999) |
| Enumeration Date | 2013-02-13 |
| Last Update Date | 2014-12-04 |