| NPI | 1356423743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 21907) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305204778) |
| 225100000X Physical Therapist | |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2018-10-16 |