| NPI | 1407352461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305212098) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 11668) |
| Enumeration Date | 2018-03-30 |
| Last Update Date | 2018-07-17 |