| NPI | 1407123243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 21705) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305207209) |
| Enumeration Date | 2011-11-22 |
| Last Update Date | 2022-03-10 |