| NPI | 1326422304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: NC P15734) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305209388) |
| 225X00000X Occupational Therapist (Licence: FL OT16107) | |
| Enumeration Date | 2015-07-19 |
| Last Update Date | 2015-09-23 |