| NPI | 1346670486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P16958) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305208222) |
| Enumeration Date | 2013-11-26 |
| Last Update Date | 2017-04-11 |