| NPI | 1417199274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305205764) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WV 002380) |
| Enumeration Date | 2009-03-25 |
| Last Update Date | 2019-04-09 |