| NPI | 1407418387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305212841) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2019-07-01 |
| Last Update Date | 2019-07-01 |