| NPI | 1326024530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DC PT870954) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305006263) |
| Enumeration Date | 2005-12-20 |
| Last Update Date | 2016-01-06 |