| NPI | 1447431788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305209915) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: SC 2171) |
| 225200000X Physical Therapy Assistant (Licence: VA 2306603760) | |
| Enumeration Date | 2007-11-15 |
| Last Update Date | 2015-12-05 |